The incidence of cervical artery dissection is unknown. In some series of young patients with stroke, dissection accounts for one fifth to one tenth of cases. 1 Internal carotid artery dissections are widely-known and as a diagnosis are more often sought. 2,3 Although there has been a recent increase in the ABSTRACT: Background and objectives: Internal carotid artery dissection has been extensively studied and well-described. Although there has been a recent increase in the number of reported cases of vertebral artery (VA) dissection, the clinical variety of presentation and the early warning symptoms have not been well-described before. Our objectives in this study include: (1) To determine the early symptoms and warning signs which may help the clinician in the early identification and treatment of patients with VA dissection. (2) To explore the variety of clinical presentation of VA dissection and its relation to prognosis. Design and setting: Retrospective analysis of hospital records in a tertiary academic centre for the period 1989-1999. Results: Twenty-six patients were identified (13 men and 13 women). The mean age was 48. Possible precipitating factors were identified in 14 patients (53%). Sporting activity and chiropractic manipulations were the most common (15% and 11% respectively). Headache and/or neck pain was the prominent feature in 88% of patients and was a warning sign in 53%, preceding onset of stroke by up to 14 days.

We report a case of fever of unknown origin in an immunocompetent patient as the first manifestation of primary central nervous lymphoma. To our knowledge this is the first reported case in the literature of this association. We recommend brain imaging to be considered in patients presenting with fever of unknown origin and no apparent diagnosis after extensive investigation.

Acute appendicitis is the most common cause of acute abdomen. Most of the cases are diagnosed on history, clinical examination and raised TLC but gangrenous and perforated appendicitis are difficult to diagnose. The TLC, Serum bilirubin and C-reactive protein (CRP) have been shown to indicate perforation in appendicitis. Objectives: The purpose of this study was to evaluate the role of TLC, hyperbilirubinemia and CRP in the diagnosis of perforated appendix and surgery should be planned. Material & Methods: This study consisted of patients admitted with the clinical suspicion of acute appendicitis. ALVARADO score was calculated. 120 patients with ALVARADO score more than 6 and histologically diagnosed appendicitis were finally included in the study. A proforma was filled which included patients name, age, sex, duration of pain, TLC count, C-Reactive protein (CRP) level and serum total bilirubin level and diagnosis of appendicitis (acute appendicitis, gangrenous appendicitis and perforated appendicitis. Patients were divided into 3 groups. Group A comprised of patients with features of simple appendicitis (AA), Group B Gangrenous appendicitis (GA) and group C Perforated appendicitis (PA). Results: There were 81 patients of acute appendicitis, 13 patients of gangrenous appendicitis and 26 patients of perforated appendicitis. TLC was raised in 13 patients of AA, 10 patients of gangrenous appendicitis and 24 patients of perforated appendicitis. Hyperbillirubinemia (>1mg/dl) was present in 9 patients of GA and 20 patients of PA. Raised C-Reactive protein level (>5mg) was present in 10 patients of GA and 21 patients of PA. There was significant correlation of raised TLC, hyperbillirubinemia and C-reactive protein in gangrenous and perforated appendicitis and p value was less than 0.05. Predictive value of bilirubin in GA and PA was 56.25 % and 74.04 %respectively. Predictive value of C Reactive Protein in GA and PA was 41.66 and 60 respectively. Predictive value of TLC in GA and PA was 43.47 and 60.86 respectively. Conclusion: All the patients who present with pain in right iliac fossa, lower abdominal tenderness and rigidity, Alvarado score>7, raised TLC, CRP and hybillirubinemia are the suspected case of perforated appendix and should be aggressively resuscitated and operated.

Background: Diabetic patients presenting with Fournier gangrene have the highest mortality rate of all at-risk populations. Objective: To compare the efficacy of adjuvant topical oxygen therapy methods and conventional methods in the management of diabetic patients having Fournier's gangrene Methodology: This was a comparative cross-sectional study, in Surgical unit 3, Allied Hospital, Faisalabad, from 1st January to 30th June 2020. A total of 120 cases were included by systematic random sampling in the study, who were admitted either through OPD or the Emergency ward. In Group A, Topical Oxygen Therapy was given along with conventional methods. In Group B only conventional methods of wound care were applied. In group A, 100% oxygen was given in a bag with a routinely available oxygen cylinder exposing the whole affected part of the body or limb. Oxygen in the chamber was given for a maximum of one and a half hours twice daily in one sitting for 7 to 10 days. In the interval between cycles, the wound was covered with a soaked antiseptic dressing. After clinical improvement, the patient was discharged and called for follow-up in outdoor on weekly intervals initially and then fortnightly for up to 6 months. Results: Mean age was calculated as 36.45±10 and 35.38±9 years in Group-A and B respectively. Comparison of the efficacy of adjuvant topical oxygen therapy and conventional methods in the management of Fournier’s gangrene showed that 44 (73.3%) in Group-A and 29 (48.3%) in Group-B had efficacy (p=0.00). Conclusion: Efficacy of adjuvant topical oxygen therapy is significantly higher when compared with conventional methods in the management of Fournier's gangrene.